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Beyond the concerns associated with marginalised groups' underrepresentation, we posited that socio-demographic aspects and associated stigma provoke gendered social exclusion among older adults. Although these linkages have been frequently acknowledged, concrete evidence remains complicated. In a sample of 384 older adults from various administrative zones of the Lahore metropolitan, we examined that gendered social exclusion is typically connected with socio-demographic stereotypes. Statistics revealed that 72.3% of older adults reported social exclusion. Homemakers and non-workers were more prone to experience social exclusion than employed respondents. Findings further discovered that the social exclusion rates were more significant among older women (93.1%) than older men (47.5%). Among older women, those involved in some employment, having a personal income, living in higher-income households and joint families with their children or peers, and having access to a private car were less possibly socially excluded. The substantial gender aspect of social exclusion appears to be provoked by a gender-based socio-cultural context, limiting older women's participation in daily socio-economic pursuits. Finally, possible consequences of increased social exclusion among older women and strategies to cater to this emerging issue are discussed. [ABSTRACT FROM AUTHOR]

Coronavirus pandemic has caused severe consequences on traveling behavior since its inception into the world in 2019. The government authorities have declared protective means to limit transportation while discouraging community congregations by giving guidelines to have social distancing with maintaining a healthy lifestyle which will lower the growth of the viral infection. This study aims to evaluate and assess the considerable changes in the mobility pattern and travel behavior of the residents of Lahore during lockdown which have slow down the virus' spread. The mobility patterns were studied through Google database 1 in the form of google mobility reports. Data obtained from the COVID-19 website of Pakistan was examined by GIS and converted into statistical data comprising of graphs and figures by authors. The findings of this research are that the COVID-19 pandemic has had a profound impact on transportation and air quality in Lahore, resulting in changes in travel behavior, reduced traffic congestion, and improved air quality, which have both positive and negative effects on public health and the environment. These findings indicate that the implementation of air quality control plans can lead to a significant improvement in air quality in Pakistan. However, the economic hardships caused by the pandemic also need to be addressed. This research shows that the public can adapt to changes in policies and travel behaviors during the pandemic. These implications can be applied to design more sustainable transportation policies in the future. [ABSTRACT FROM AUTHOR]

The population is increasing rapidly globally, and urban expansion of the cities has become an extensive trend in developing nations. Urban expansion patterns, such as transportation structure and road networks, affect transportation planning. This research was conducted on a mega project in Lahore city of Pakistan, i.e., the Lahore Ring Road (LRR) project. Limited research focused on the beneficiary assessment of the road project, and this research was carried out to fill this research gap. This research aims to evaluate the beneficiary assessment of DHA Phase 8 and Halloki Settlement along the Lahore Ring Road. The simple Random Sampling technique was used to conduct the household survey in the study area. This study concluded that most of the residents did not modify their houses nor increase the built-up area and height after the introduction of the project. This study inferred that the rental potential was high at some locations and low at old existing settlements. This research further concluded that community participation was ignored, and public facilities were not improved in the study area. But a project of LRR was very much beneficial and alive for the residents of Lahore city. Community participation should be enhanced in such types of megaprojects, and allied facilities in the nearby community should be upgraded. This research will be helpful for policymakers, urban planners, transportation planners, development authorities, and other stakeholders in planning future road projects in the country. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) caused by the novel coronavirus-infected millions globally. Despite a wide range of advised options for the treatment of COVID-19, a single strategy to tackle this pandemic remains elusive, thus far. That is why we are conducting a clinical trial to find out the efficacy of iodine complex to clear a viral load of severe respiratory syndrome coronavirus-2 (SARS-CoV-2) along with a reduction in time taken to alleviate symptoms.Method: The proposed study is a placebo-controlled, add-on, randomized trial using parallel group designs. This is a closed-label and adaptive with sample size reassessment, multi-centered design with a 1:1:1:1 allocation ratio and superiority framework. It will be conducted in Shaikh Zayed Post-Graduate Medical Complex, Ali Clinic, and Doctors Lounge, Lahore, Pakistan. This study will have three arms of mild to moderately symptomatic COVID-19 patients (50 patients in each) which will receive ionic-iodine polymer complex with 200 mg of elemental iodine: interventional arm A will have encapsulated, arm B will receive suspension syrup form, arm C will get throat spray, while arm X will be standard care with placebo. Data will be collected on self-constructed, close-ended questionnaires after obtaining written consent. Data will be analyzed using SAS version 9.4. COVID-19 patients will be monitored by RT-PCR and HRCT (high-resolution computed tomography) chest. In addition to these, the duration of the symptomatic phase and mortality benefits will be analyzed in both groups.Discussion: The study is designed to measure the superior efficacy of the iodine complex as an add-on in treating COVID-19-positive patients with mild to moderate symptoms. This combination is hypothesized to improve various parameters like rapid viral load reduction, clinical and radiological improvement, lower mortality, and reduction in hospitalization. The trial will aid in devising a better strategy to cope with COVID-19 in a relatively inexpensive and accessible way. The implications are global, and this could prove itself to be the most manageable intervention against COVID-19 especially for patients from limited-resource countries with deprived socioeconomic status.Trial Registration: ClinicalTrials.gov NCT04473261 . Registered on July 16, 2020. [ABSTRACT FROM AUTHOR]

Objective: To assess the predictors associated with mortality within 8 weeks in patients undergoing endoscopic N-butyl-2-cyanoacrylate treatment. Study Design: Prospective comparative study. Place and Duration of Study: Department of Gastroenterology, Services Institute of Medical Sciences, Lahore Pakistan, from Mar 2018 to Mar 2019. Methodology: A total of 106 patients of gastric variceal bleed were enrolled in the study. Tissue glue was injected into the varix endoscopically and mortality within 8 weeks after endoscopic intervention was noted. Results: Among the enrolled patients, 65 (61.3%) were male and 41(38.7%) were female. Mortality was noted in 19 (17.9%) patients within 8 weeks after endoscopic therapy. Chi-square analysis showed creatinine >1.5, Child Pugh score >9, MELD score >18, re-bleeding within 7 days, low blood pressure <90/60 at presentation and hepatic encephalopathy as significant predictors of mortality (p<0.005). Conclusion: Cirrhotic patients undergoing endoscopic injection of gastric varix with N-butyl 2-cyanoacrylate after gastric variceal bleed have high risk of death within 8 weeks. [ABSTRACT FROM AUTHOR]

This study was carried out to analyze the phytochemical profile of Euphorbia prostrata Aiton through GC-MS and identification of possible antifungal, antibacterial and other pesticidal compounds through literature survey. Whole plant material of the weed was collected from Lahore, Pakistan and shade dried followed by two-week extraction in ethyl acetate. The filtrates were analyzed by GC-MS that showed the presence of 19 compounds. The major compound in the extract was 9,19-cyclolanost-24-en-3-ol, (3β)- (24.62%) followed by 9,19-cyclolanostan-3-ol, 24-methylene-, (3β)- (19.51%) and γ-sitosterol (12.51%). Other compounds were phytol (8.11%), n-hexadecanoic acid (6.15%), 9,12,15-octadecatrienoic acid, (Z,Z,Z)- (4.90%), neophytadiene (4.88%), cyclohexane, 1,3,5-triphenyl- (3.71%), hexadecanoic acid, ethyl ester (3.04%), phenol, 2,2'-methylenebis[6-(1,1-dimethylethyl)-4-methyl- (2.42%), octadecanoic acid, ethyl ester (2.24%), octacosane (2.11%), 1-heptacosanol (1.71%), stigmasta-5,24(28)-dien-3-ol, (3β,24Z)- (1.71%), 9,12,15-octadecatrienoic acid, ethyl ester, (Z,Z,Z)- (1.29%), oxirane, hexadecyl- (1.21), 9,12- octadecadienoic acid (Z,Z)- (1.05%), Z-8-methyl-9-tetradecenoic acid (1.01%), and 9-octadecyne (0.76%). Literature survey revealed that eight compounds possess antibacterial, antifungal, nematicidal and/or insecticidal properties. Most of the pesticidal compounds were antibacterial in nature. [ABSTRACT FROM AUTHOR]

It was a descriptive research which studied the use of non-verbal communication in the pedagogic practices at secondary school level in Lahore. The study was conducted to examine the practices of teachers' non-verbal communication used in conjunction with verbal communication in actual classroom setting by teachers which affected the participation and performance level of learners. It investigated the students' understanding, interpretation of and attitude towards non-verbal communication used by teachers and identified the existing barriers for the use of non-verbal communication strategies to improve students' learning. The non-verbal communication was restricted to five factors--physical appearance, facial expressions, eye contact, spatial distance and paralinguistic. The study was limited to the subject of English (compulsory) at the female secondary schools in public sector. The sample comprised of 1200 students and 40 teachers from female public high schools of Lahore (Punjab), Pakistan. The study recommended that all female teachers at secondary level schools should be provided an orientation in non-verbal communication which would help them to use these skills in their teaching methodologies. While recognizing the importance of non-verbal communication, the curriculum planners and policy makers should take practical steps to make it a part of teacher education programs for the training of prospective teachers. Moreover, an awareness among students shall be created on how to interpret and reflect upon the teachers' non-verbal communication signals during teaching-learning process. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety profile of Hasson’s technique of laparoscopic port access in patients undergoing laparoscopic cholecystectomy. Study Design: Cross-sectional study. Place and Duration of Study: Department of general surgery, Combined Military Hospital Lahore, from Oct 2014 to Aug 2018. Methodology: A total of 1037 patients with acute or chronic cholecystitis who were scheduled for laparoscopic cholecystectomy were included. Hasson (open) technique was used to insert first laparoscopy port for creation of pneumoperitoneum. Following laparoscopic cholecystectomy, data of intra-operative and post-operative complications was noted. Patients were followed during hospital stay to evaluate any procedure related injury. Follow-up was done at up-to six months to determine wound infections and formation of umbilical hernia. Results: Mean age of the patients was 44.65 ± 8.98 years. Out of 1037 patients, procedure was simple in 655 (63.16%) patients and complex in 382 (36.83%) patients due to the presence of inflammatory adhesions and anatomic access. There was no intra-abdominal injury, omental injury, vascular injury or gut perforation. Port-site infections were diagnosed in 6 (0.57%) patients during 06 months’ follow-up. Umbilical hernia was diagnosed in only 1 (0.09%) patient. Conclusion: We found that Hasson technique of first laparoscopy port access for creation of pneumoperitoneum was a safe technique with minimum number access related complications. [ABSTRACT FROM AUTHOR]

Objective: To determine efficacy of diclofenac suppository in reducing post-ERCP pancreatitis (PEP) and identify risk factors for PEP. Methods: This is a placebo-based prospective study at Department of Medicine & Gastroenterology, Services Institute of Medical Sciences / Services Hospital, Lahore performed from January 2018 to June 2019. Patients were randomized to receive diclofenac suppository or glycerine suppository before ERCP. Both groups were compared for PEP using chi square x2 test while risk factors for PEP were determined using binary logistic regression. Results: Total of 165 patients with mean age 49.1(±15.2) and male to female ratio 1/1.6 (63/102) were included. Among 82 (49.7%) patients in diclofenac group, 8 (9.7%) developed pancreatitis while 19(22.9%) of 83(50.3%) in placebo group had PEP (p value 0.02). After multivariate analysis, age>45 years (p value 0.014, OR 3.2), Bilirubin >3 mg/dl (p value 0.004 OR 3.58), time to cannulation> 5 minutes (p value<0.000 OR 9.2), use of precut (p value< 0.000 OR 4.9), pancreatic duct cannulation (p value 0.000 OR 5.46) and total procedure time >30 minutes (p value 0.01 OR 3.92) were risk factors for PEP. Conclusion: Pre-procedure Diclofenac suppository reduces post-ERCP pancreatitis. Age > 45 years, serum bilirubin > 3 mg/dl, cannulation time > 5 minutes, use of precut, pancreatic duct cannulation and procedure time > 30 minutes are risk factors for post-ERCP pancreatitis. [ABSTRACT FROM AUTHOR]

Objective: To validate a clinical scoring system for defining the severity of ailment that will assist in developing strategies for management prioritisation. Study Design: Cross-sectional analytical study. Place and Duration of Study: Paediatric Department, Combined Military Hospital Lahore, Pakistan, form Jan 2020 to Jul 2021. Methodology: The paediatric patients who reported to the Medical Reception Centre and were admitted to an Inpatient Facility were enrolled. Demographic profile, temperature, oxygen saturation, pulse, respiratory rate, seizures, and sensorium labelled as "TOPRS" score was recorded with "0 - Normal" and "1 - Abnormal" and scores calculated for each patient with the incorporation of systemic inflammatory response and advanced paediatric life support criteria. Results: A total of 300 paediatric patients with an age range of 1-18 years (mean: 3.86±5.43) were included. Of 300 patients, 237(79%) were discharged after improvement, and the mortality rate was 63(21%). A significant association with the mortality rate was deciphered with temperature, oxygen saturation, and respiratory rate variables. In contrast, pulse rate, sensorium, and seizures were concluded to have an insignificant association. Score "0" mortality was associated with the 4.4% mortality, whereas score "5" enumerated an 80% death rate. Conclusion: The TOPRS clinical scoring system has significant value in the diagnosis of mortality and morbidity of paediatric patients and, hence, can assist in early recognition and triage of patients, consequently aiding in the provision of prioriti sation protocols and management in a befitting manner. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of adjuvant Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF) therapy in neonatal sepsis. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital, Lahore Pakistan, Mar 2019 to Mar 2020. Methodology: Thirty neonates (15 cases and 15 controls) were randomly selected for this study. The Interventional Group was given GM-CSF and standard-of-care treatment; the Control Group only received standard care. Both groups were followed for the primary outcome (i.e., discharge or death). Secondary outcomes included the effects of GM-CSF on haematological parameters of neonatal sepsis. Results: The mean gestational age of the children was 33.46±2.47 weeks. In the Interventional-Group, 56.7% of the neonates were discharged with the resolution of the sepsis. There was no significant difference concerning the secondary outcome, but the mortality was higher in the neonates among the Control-Group (p-value>0.05). Conclusion: Our study showed no difference in mortality between the Interventional and the Control Groups. The GM-CSF therapy could be used as an adjuvant therapy in neonates with neonatal sepsis to increase the total leukocyte and absolute neutrophil counts. Further studies are needed to holistically chart the clinical benefit of GM-CSF adjuvant therapy. [ABSTRACT FROM AUTHOR]

Objective: To compare efficacy of high vs low dose rifaximin for primary prophylaxis of portosystemic encephalopathy (PSE) in decompensated liver cirrhosis. Methods: In a quasi-experimental double blind randomized study at Services Institute of Medical Sciences (SIMS), Lahore from August 2017 to August 2018, patients of decompensated cirrhosis with no previous PSE were randomized to receive twice daily rifaximin 200mg in Group-A and 550mg in Group-B. Patients were followed for 6 months for development of PSE. Results: In 75 included patients, mean age was 53.8(±10.7) years and male/female ratio was 0.97/1(37/38). After randomization, 34 (45.3%) patients were included in Group-A and 41 (54.7%) patients in Group-B. During 6 month follow up 24 (32%) patients developed PSE, 12 (35.2%) in Group-A and 12 (29.2%) in Group-B, difference was not significant (p value 0.57). In 6 months, 13 (17.3%) patient died, 6 (17.6%) in Group-A and 7 (17.07%) patients in Group-B, difference not significant (p value 0.94). Patients who died had higher bilirubin (p < 0.00), higher serum creatinine (p 0.05), high CTP score (p 0.04) and worse MELD score (p 0.004). Conclusion: Rifaximin is not effective for primary prophylaxis of overt hepatic encephalopathy in decompensated cirrhosis patients. [ABSTRACT FROM AUTHOR]

Food habits, nutrient preferences, and roost variations of Indian flying fox Pteropus giganteus were investigated for a period of 1 year in two public parks in Lahore, Pakistan. Bolus and guano samples of P. giganteus were collected on a monthly basis, and seeds of 32 plant species belonging to 23 genera and 15 families were identified from the ejecta samples. Of these 32 food species, 8 were native and 24 were exotic; 13 were commercially important, while 19 species had no mercantile value. Proximate analysis of the food items revealed that fruits with comparatively higher moisture content were utilized during summer; fruits having relatively higher carbohydrates, fibers, protein, fats, phosphorous, iron, and sodium were used during winter; diets having relatively greater calcium and vitamin C contents were used during autumn; and phosphorous-rich diets were used during spring. Permanent roosting trees (n = 50) representing 17 families, 19 genera, and 21 species were monitored to record the abundance and roost fidelity of P. giganteus. The maximum number of bats (n = 425) was recorded for Dalbergia sissoo during summer, Kigelia pinnata (n = 270) during spring, Celtis australis (n = 374) during autumn, and Cedrela toona (n = 330) during winter. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the study is to measure the efficacy of ionic-iodine polymer complex [1] for clinical and radiological improvement in coronavirus disease 2019 (COVID-19) patients.Trial Design: The trial will be closed label, randomized and placebo-controlled with a 1:1:1:1 allocation ratio and superiority framework.Participants: All PCR confirmed COVID-19 adult patients including non-pregnant females, with mild to moderate disease, will be enrolled from Shaikh Zayed Post-Graduate Medical Complex, Ali Clinic and Doctors Lounge in Lahore (Pakistan). Patients with any pre-existing chronic illness will be excluded from the study.Intervention and Comparator: In this multi-armed study ionic-iodine polymer complex with 200 mg of elemental iodine will be given using three formulations to evaluate efficacy. Patients will be receiving either encapsulated iodine complex of 200 mg (arm A), iodine complex syrup form 40 ml (arm B), iodine complex throat spray of 2 puffs (arm C) or empty capsule (arm D) as placebo; all three times a day. All the 4 arms will be receiving standard care as per version 3.0 of the clinical management guidelines for COVID-19 established by the Ministry of National Health Services of Pakistan.Main Outcomes: Primary outcomes will be viral clearance with radiological and clinical improvement. SARS-CoV-2 RT-PCR and HRCT chest scans will be done on the admission day and then after every fourth day for 12 days or till the symptoms are resolved. RT-PCR will only be shown as positive or negative while HRCT chest scoring will be done depending on the area and severity of lung involvement [2]. Time taken for the alleviation of symptoms will be calculated by the number of days the patient remained symptomatic. 30-day mortality will be considered as a secondary outcome.Randomisation: Stratification for initial COVID-19 status (or days from initial symptoms as a proxy), age groups, gender, baseline severity of symptoms and co-morbidities will be used to ensure that the study arms remain balanced in size for the 1:1:1:1 allocation ratio. Randomization will be done using the lottery method. As patients are being admitted at different times, they will be recruited after obtaining their voluntary written informed consent following all standard protocols of the infection, control and disinfection.Blinding (masking): This is a quadruple (participants, care providers, investigators and outcomes assessors) blinded study where only the study's Primary Investigator will have information about the arms and their interventions.Numbers To Be Randomised (sample Size): 200 patients will be randomized into four groups with three experimental and one placebo arm.Trial Status: Protocol Version Number is 2.3 and it is approved from IRB Shaikh Zayed Hospital with ID SZMC/IRB/Internal0056/2020 on July 14th, 2020. The recruitment is in progress. It was started on July 30, 2020, and the estimated end date for the trial is August 15, 2021.Trial Registration: Clinical Trial has been retrospectively registered on www.clinicaltrials.gov with registration ID NCT04473261 dated July 16, 2020.Full Protocol: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). With the intention of expediting dissemination of this trial, the conventional formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines. [ABSTRACT FROM AUTHOR]